MEDICARE: DAVID R TOMAZIC DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	0S004178L	PA
2	207Q00000X	Family Medicine Physician	0S004178L	PA

General Provider Information

NPI Number	:	1912992751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID R TOMAZIC DO

Provider Business Mailing Address
First Line	:	601 PARK ST
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-1445
Country	:	US
Telephone Number	:	570-785-3194
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 DUNDAFF ST
Second Line	:
City	:	FOREST CITY
State	:	PA
Zip	:	18421-1317
Country	:	US
Telephone Number	:	570-785-3194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	03/05/2020

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Directions to “ DAVID R TOMAZIC DO” Practice Location

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